Continual patient monitoring in certain types of patient condition becomes a necessity to assure timely intervention by a healthcare practitioner or a physician to initiate the right medical procedure or administer the required medication in a timely manner. Situations with high-risk patients in the areas of cardiology, obstetrics, neurology, psychology are but some examples where continual remote patient monitoring becomes a patient care necessity.
With increasing hospitalization costs for patients, health insurance companies and health maintenance organizations are encouraging more and more patients to reduce the duration of hospitalization if hospitalization is an absolute necessity. In the face of increasing healthcare costs, certain kinds of treatment, including chemotherapy, antibiotic therapy, infusion therapy and pneumonia treatment are all considered relatively safe, cost effective home treatments. Several infusion devices have been approved by the FDA with the proviso that such devices be calibrated at regular intervals as prescribed. There are other situations such as in the field of obstetrics wherein patients are encouraged to wait as long as medically desirable before patients enter a hospital for childbirth. Typically, in the obstetrics patient situation, a patient, by home monitoring of the frequency and duration of uterine contractions can determine if it is time to enter a hospital or any other facility for childbirth. Such determination however needs patient participation or intervention. There may be situations however, where patient participation is not possible or patient intervention is not to be relied upon, but patient monitoring is nevertheless necessary. Another example of such a situation is a cardiac patient. A reliable but expensive method of monitoring in such situations is for a nurse or healthcare worker or a physician to meet the patient in person to do the monitoring. Notwithstanding, if continual monitoring is necessary, it will then necessitate the nurse or healthcare worker or physician to be physically present at the patient site during the monitoring. This will limit the number and type of patients that can be covered in a given time by a healthcare worker.
Some solutions to the above problem are offered by patient care monitoring services which sometimes are offered by health maintenance organizations (HMO). Statistics indicate that corporate healthcare benefits represented about 5% of the payroll in 1980 as compared with 14% in 1990. Part of the corporate healthcare benefits are patient monitoring costs, and reducing such costs will be a very attractive proposition. In any event it is important to note that avoidance of clinically unnecessary outpatient visits can be a key to reducing healthcare costs, if insurance liability can be reduced and the clinical integrity preserved.
It is known in prior art to generate signals representing a patient's condition and record them for later scrutiny by a physician. An example of such is the well known Holter heart monitor, wherein a continuous 24 hour cardiogram of a patient is recorded by a monitor which is worn by the patient. Functionally however, in such a monitoring system a healthcare worker or a physician is not alerted by any emergency situation which could occur during the duration of the monitoring.
The underlying considerations in providing improved health monitoring services for high risk patients include the facts that:
(i) a high risk patient likes to hear the doctor's voice during the monitoring interaction; PA1 (ii) the doctor has the responsibility to determine in a timely manner as to whether an appointment is necessary, PA1 (iii) the doctor should have the opportunity of determining if the high risk patient is in need of any urgent medication or any change in the treatment, PA1 (iv) it is often undesirable for monitoring to be done by patient intervention especially in situations like acute hypertension cases or serious perinatal cases. PA1 (v) it is desirable to minimize the continuous use of a nurse or other healthcare worker to personally attend to the patient and do the monitoring, PA1 (vi) it would be undesirable and disadvantageous to use acoustic telephone devices like modems which would be ineffective and uneconomical to use for remote monitoring purposes, and PA1 (vii) it is desirable if a physician/doctor could attend simultaneously and remotely to a large number of high risk patients so that doctor intervention or other remedial measure could be initiated when necessary and no sooner.
Previous approaches by others to address this problem in general, as aforesaid, have been to use an intermediary, (a visiting nurse, or similar representative) to call on the patient, and take the physical data (temperature, pulse, blood pressure, fetal heart monitor, glucose level, etc. ), and report those results to the clinicians' office by mail or telephone. This means that only the recorded physical data is being obtained. The physical data must still be viewed by the doctor to evaluate his patient. And, again, another level of human intervention to monitor the patient is required for each patient. Health software services, such as Healthdyne,.RTM. Inc. use a nurse to transmit the data from the patient, and then their software evaluates the patient's medical condition. Both of these methods are costly because of the human intervention of a healthcare worker or a nurse visiting each patient.
This is not the same as a doctor himself, speaking to each of his high-risk patients, evaluating their need for attention, and obtaining the data from the monitoring devices on those patients simultaneously.
There is need for an improved patient monitoring system including method and apparatus, which is both patient friendly and doctor friendly and increases the patient care quality without increasing clinically unnecessary patient visits. There is also need for such a system to be accurate and reliable, to use normal telephone lines, to be easy for maintenance, future upgrading, additions and changes.
The present invention provides a health monitoring system including method and apparatus for monitoring, without patient intervention and using artificial intelligence, the medical condition of a remotely located patient by means of monitor-generated signals through telephone lines reaching an interface to the medical expert system application. Voice technology and AI are integrated in the innovative system offering significant economic benefits in the home healthcare industry. As described hereinafter, the AI used in the innovative health monitoring system is governed by physician-provided guidelines, standards and approach. Advantageously, the patient is presented questions in the physician's own voice, and the questions and their pattern would be chosen from prerecorded conversation of the physician which would be parsed and presented to the patient depending on the patient's response to each question and as guided by AI.
A clear benefit is perceived by the patients using the inventive monitoring system in that they view the physician "conversation" as providing an increased level of physician contact, concern and care. Such a patient perception becomes a significant marketing tool for the inventive system in the healthcare industry. The innovative monitoring system described hereinafter provides for simultaneous multiple monitoring of several high risk patients who might have different types of ailments. The system described and claimed herein allows a medical practitioner, hospital, or group health provider to expand their service market, without risk of losing quality of service. In fact, it is the consistent application of the physician-provided rules of monitoring patient parameters that allows the system to advise the doctor routinely about his patients. He can be more productive because he is directed to critical patient needs, while unnecessary outpatient visits are reduced. Moreover, the fact that the multiple physician-patient "conversations" are initiated by the system, and can be carried on simultaneously, means that the physician is increasing his services without increasing his time to converse with patients.
Because of the AI/Voice technology combination, appropriate clinical questions are asked, (through "reasoning" about a response, and branching to another relevant question, or portion of a question)--by a physician, forward and backward chaining in Artificial Intelligence. In addition, the AI/Voice technology allows it to simultaneously carry on multiple (approximately 48) conversations, monitoring the results, and to include features such as call monitoring, call forwarding, and call recording whenever physician-directed rules indicate that intervention and alarming are needed. Thus, if an HMO were providing high-risk pregnancy patients with home health monitoring, the obstetrician would be notified immediately of an out-of-limits fetal heart rate on a patient. The system would detect the change, notify the HMO monitoring assistant by opening a window on their computer screen, merging recent medical data on the patient, and also forwarding the call to the HMO monitoring assistant. It is to be noted that in all of its functionality, the AI/Voice/Monitoring is not intended to diagnose; rather it advises the clinician of possible need to intervene.
Physicians who would use the inventive monitoring system would easily view the system as a superior clinical tool, since it frees them from being tied to one high risk patient at a time and also since they are not relying upon a patient to read a monitoring device. The system allows a physician user to be warned of critically-ill patients automatically according to the physician's own chosen guidelines as controlled by the AI.
In a preferred embodiment described hereinafter a DECvoice 1-168 VAX System is used which offers the capability of simultaneously monitoring 48 remote patients all connected in to a central monitoring and recording system, such as for e.g., a computer integrated telephone system.